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Choosing Wisely

Modern medicine has given us more ways than ever to diagnose and treat illness. But there’s mounting evidence more tests and procedures don’t always equal better care. Sometimes, the best option may be to do nothing.

The potential harm to consumers from unnecessary medical tests and treatments is the trigger for Choosing Wisely, a campaign launched this month by the Council of Medical Colleges (CMC) in partnership with us and the Health Quality & Safety Commission.

The campaign already operates in Australia, Canada, the UK and US. It aims to help consumers make more informed choices about healthcare, focusing on treatments evidence shows provide little or no benefit and could cause harm – as well as waste time and money better spent on improving healthcare elsewhere.

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About Choosing Wisely

Just because tests and treatments are available doesn’t mean we should always use them, says CMC chair Dr Derek Sherwood. He points to X-rays for people with back pain as among the tests that need to be considered carefully before use. Back pain is one of the most common reasons we visit the doctor. But evidence shows most of us recover without needing scans or other tests.

“Not only do X-rays and CT scans expose patients to potentially cancer-causing radiation but many studies have shown scans frequently identify things that require further investigation but turn out to be nothing. This means patients can undergo stressful and potentially risky follow-up tests and treatments,” he says.

The reasons why unnecessary interventions occur vary. Dr Sherwood says common factors across countries include lack of consultation time, fear of missing a diagnosis, malpractice concerns, financial incentives and the challenge of telling patients they don’t need specific tests.

“The result can be care for patients that adds little or no value and may cause harm.” Unnecessary prescription of antibiotics is among the starkest illustrations of no-value, high-risk interventions. Over-use of antibiotics is a major factor in antibiotic resistance, a global problem that could see a rise in antibiotic-resistant superbugs.

Latest figures show antibiotic consumption in New Zealand jumped 49 percent between 2006 and 2014. Data suggest our use is comparatively high by international standards. In 2013, New Zealand’s antibiotic consumption was higher than 22 out of 29 countries surveyed by the European Centre for Disease Prevention and Control.

Research published this year by the Institute of Environmental Science and Research reported a large number of antibiotics may also be prescribed where there’s no clear benefit, such as for treating seasonal colds and flu. Colds and flu are caused by viruses, not bacteria that antibiotics are designed to kill.

4 questions to ask

Choosing Wisely is encouraging a change in thinking by health professionals and consumers to avoid unnecessary medical treatment. When you visit your doctor, ask them the following questions:

Do I really need this test, treatment or procedure?

Tests can help diagnose the cause of a problem, and treatments and procedures may help you recover. Understanding why your doctor is considering a test or treatment is always advisable.

What are the risks?

Ask your doctor about the risks involved with a test or treatment. What does the test involve? Are there side effects? What’s the likelihood of inaccurate results or finding something that may never cause symptoms? Discuss the risks with your doctor and weigh them against possible benefits of treatment.

Are there simpler, safer options?

There may be actions you can take yourself to aid recovery. Lifestyle changes – improving diet and exercising regularly – have a much greater impact on our health over the long-term than medical interventions.

What happens if I do nothing?

Ask your doctor about what might happen if you delay treatment or don’t have the test. What’s the likelihood of your condition improving without intervention? Does evidence show a wait-and-see approach is a good option?

The Choosing Wisely campaign is also encouraging health professionals to discuss these issues with their patients. Seventeen medical colleges and societies in New Zealand have developed recommendations about tests, treatments and procedures that should be avoided.

Consumer NZ is supporting the Choosing Wisely campaign by providing information to assist discussions between consumers and healthcare professionals.

Tell your doctor if you don’t understand something and ask them to explain it again or write it down. If you feel hesitant about asking questions, take along a support person. You can also ask for recommendations for further reading so you feel informed about the issue.

FAQs

Choosing Wisely is not about saving money, although this may happen as a result of the campaign. It is about making sure patients receive the best and most appropriate care based on evidence, and are not put at risk by having unnecessary tests, treatments and procedures.

Choosing Wisely focuses on areas where evidence overwhelmingly shows that a test, treatment or procedure provides little or no benefit to a patient, and could even cause harm. These are not grey areas where the evidence is debatable.

Availability of appropriate care is a problem especially in some areas and for some groups of people. Choosing Wisely has the potential to free up resources by reducing the use of unnecessary tests, treatments and procedures.

Choosing Wisely is not suggesting tests, treatments and procedures be stopped. It’s saying the use of some should be reviewed with more careful consideration of the patient’s needs and evidence of effectiveness for any proposed course of action.

The campaign is funded by:

  • Council of Medical Colleges
  • Ministry of Health
  • Health Quality & Safety Commission.

There has also been support in various forms from many health sector groups and assistance from New Zealand medical colleges.

Antibiotic use: 2006-2014

Year Amount (number of defined daily doses per 1000 population per day)
200617.29
200719.47
200821.73
200922.79
201023.61
201124.99
201225.89
201325.91
201425.77

GUIDE TO THE TABLE DATA are sourced from Antibiotic Consumption in New Zealand 2006-2014, a report prepared for the Ministry of Health by the Institute of Environmental Science and Research in May 2016.

Do More Screening Tests Lead to Better Health?

Dr. Mike Evans from the College of Family Physicians Canada (CFPC) discusses appropriate screening in one of his famous “White Board Videos”.

[choosing-wisely-mike-evans]

Choosing Wisely: a parody of “Happy”

James McCormack teaches the concept of Choosing Wisely in his parody of the Pharrell Williams song “Happy”.

[choosing-wisely-happy]

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